Download

Published

Journal

Author(s)

Metadata

Abstract

This case study aims to identify how
Ethiopia has adopted and implemented strategies to improve
health services, including the factors that enabled and
inhibited success across a meaningful range of health
services for the period 1996-2006. Particular emphasis has
been given to the impact of utilized strategies on the poor.
This case study reviewed one 'primary strategy',
decentralization in the form of devolution of authority to
the regional level in 1996 and to the district (woreda)
level in 2002, and seven 'corollary strategies' in
the context of decentralization implemented at the
subnational level. The study concludes that decentralization
in the health sector is likely to be more effective when it
is implemented as part of a broader government
decentralization policy across sectors. Sequencing in
implementing Ethiopia's decentralization strategy made
decentralization more manageable, although decentralization
was rolled out prematurely. Moreover, the effectiveness of
implementation was found to be driven largely by the
institutional and management capacity at the subnational
level. At the subnational level, decentralization was found
to be more effective in those regions that increasingly
strengthened their management and institutional capacity and
where regional governments set priorities and adapted the
strategies to local needs. However, decentralization was
often influenced by the 'clientelistic' center,
region power relationship, a problem compounded by the lack
of community voice, making the available resources at risk
of political capture by the local elite. Overall, the key
lesson for implementing improvements in health service
delivery (HSD) is that the lack of any critical inputs
(facilities, health workers, and drugs) inevitably limits
the overall impact of the strategy, and that the
implementation of such key inputs should be carefully
coordinated and properly synchronized.